Provider Demographics
NPI:1992120521
Name:BOONE, MICHAEL J (LMSW)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:BOONE
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MCGOVERN LN
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-1513
Mailing Address - Country:US
Mailing Address - Phone:803-315-9713
Mailing Address - Fax:
Practice Address - Street 1:8 MCGOVERN LN
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-1513
Practice Address - Country:US
Practice Address - Phone:803-315-9713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC93471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical